慢性阻塞性肺疾病急性加重与呼吸道病毒感染的研究进展

慢性阻塞性肺疾病(COPD)是一种呼吸道常见的炎症性疾病,是全世界发病率和病死率较高的疾病之一。慢性阻塞性肺疾病急性加重(AECOPD)是其过程中的重要事件,常导致患者生活质量下降,病死率升高。呼吸道病毒感染与AECOPD密切相关。AECOPD的患者病毒感染具有多样性、季节性及地域性等特点。呼吸道病毒感染可通过活化炎症细胞及介质,参与免疫反应使COPD加重。各种各样的病毒感染对AECOPD的影响及机制可能不同,需要进一步研究。     

慢性阻塞性肺疾病急性加重期患者预后预测评估工具的研究进展

正慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease, COPD,简称慢阻肺)是常见的呼吸系统疾病,其发病率和病死率均较高,是重要的公共卫生挑战。因感染等原因导致的慢性阻塞性肺疾病急性加重(Acute Exacerbations of Chronic Obstructive Pulmonary Disease, AECOPD,简称慢阻肺急性加重)指的是患者在短期内症状明显加重,即咳嗽、     

人博卡病毒与AECOPD相关性研究

目的探讨人博卡病毒(HBoV)与慢性阻塞性肺疾病急性加重(AECOPD)的关系。方法PCR检测2008年11月～2009年4月55例慢性阻塞性肺疾病(COPD)患者诱导痰标本的HBoV,其AECOPD患者26例(47.3%),稳定期COPD患者29例(52.7%)。结果共发现2例HBoV阳性,AECOPD患者和稳定期COPD患者各1例,阳性率分别为3.85%和3.45%。结论HBoV不是AECOPD呼吸道感染的的重要病原,双者之间无关联性。     

慢性阻塞性肺疾病急性加重的新认识

慢性阻塞性肺疾病急性加重(acute exacerba-tion of chronic obstructive pulmonary diseases,AECOPD)是指COPD的急性起病过程,其特征是患者呼吸系统症状恶化,超出日常变异,并且导致需要改变药物治疗。AECOPD是COPD临床过程中的重要事件,频繁急性加重对生活质量产生巨大影     

慢性阻塞性肺疾病急性加重合并肺血栓栓塞症12例临床分析

慢性阻塞性肺疾病(COPD)是一种常见的慢性呼吸系统疾病,在我国40岁以上人群中的患病率高达14%。慢性阻塞性肺疾病急性加重(AECOPD)是COPD患者死亡的重要原因,对患者的疾病进程、活动耐力、生活质量及社会经济负担均产生严重负面影响。急性肺血栓栓塞症(PTE)是常见的三大致死性心血管疾病之一[1]。COPD患者处于高凝状态、因慢性缺氧致血管内皮损伤且合并细小动脉原位血栓,是PTE的独立危险因素。AECOPD患者PTE的发病率和病死率显著增高。我们通过分析12例AECOPD合并PTE患者的临床资料,旨在探讨其临床特征和诊治策略。     

本期导读

慢性阻塞性肺疾病(COPD)是一种重要的慢性呼吸系统疾病,患病率高、病死率高,社会负担重。COPD急性加重(AECOPD)是COPD的重要临床病程,长期以来,对于细菌在AECOPD的作用,一直存在争议,为此特邀蔡柏蔷教授撰写专论“关注细菌感染在慢性阻塞性肺疾病急性加重时的作用”。吸烟是COPD最主要的危险因素,但相当一部分女性COPD患者从不吸烟,尤其是农村女性,提示农村女性罹患COPD存在其他重要危险因素。“我国部分农村地区40岁以上女性慢性阻塞性肺疾病危险因素分析”一文采用多阶段分层整群随机抽样方法,选北京、上海、天津市及广东…     

慢性阻塞性肺疾病急性加重个体化治疗过程中应予关注的几个问题

急性加重(AE)是导致慢性阻塞性肺疾病(COPD)患者住院和死亡的主要原因,但患者病情各异,针对不同的急性加重期慢性阻塞性肺疾病(AECOPD)患者,有必要根据实际临床情况进行个体化治疗。AECOPD患者的个体化治疗应建立在对急性加重原因的细致鉴别诊断、对合并疾病的正确处理和治疗药物的恰当运用等基础上。抗生素的选择、曲霉菌感染、糖皮质激素、合并肺高血压、急性肺栓塞、慢性心力衰竭和睡眠呼吸暂停综合征等的处理是AECOPD患者个体化治疗过程中应予关注的几个问题。     

低分子肝素钙联合盐酸氨溴素吸入治疗老年慢性阻塞性肺疾病加重期患者的疗效

老年慢性阻塞性肺疾病急性加重期(AECOPD),不但给老年慢性阻塞性肺疾病(COPD)患者带来极大的身心痛苦,降低其生活质量,丧失劳动能力,更是威胁患者生命导致患者死亡的主要原因.如何更好地治疗老年AECOPD的患者,尤显其重要.我们对AECOPD患者采用低分子肝素钙与盐酸氨溴素(沐舒坦)联合吸入治疗,取得了满意的疗效.     

免疫增强治疗可减少慢性阻塞性肺疾病急性加重

慢性阻塞性肺疾病(COPD)是呼吸系统的常见病、多发病。我国40岁以上人群COPD的患病率为8.2%,其中每年约有数百万COPD患者反复发生急性加重(AECOPD),因COPD     

低分子肝素钙联合盐酸氨溴素吸入治疗老年慢性阻塞性肺疾病加重期患者的疗效

老年慢性阻塞性肺疾病急性加重期(AECOPD),不但给老年慢性阻塞性肺疾病(COPD)患者带来极大的身心痛苦,降低其生活质量,丧失劳动能力,更是威胁患者生命导致患者死亡的主要原因.如何更好地治疗老年AECOPD的患者,尤显其重要.我们对AECOPD患者采用低分子肝素钙与盐酸氨溴素(沐舒坦)联合吸入治疗,取得了满意的疗效.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。